Fulfillment of patients' expectations of lumbar and cervical spine surgery

Background context: Fulfillment of expectations is an important outcome of spine surgery.

Purpose: The study aimed to compare fulfillment of expectations after surgery with preoperatively stated expectations.

Study design: This is a prospective cohort study.

Patient sample: The sample included patients who had lumbar and cervical spine surgeries.

Outcome measures: The outcome measures were self-report valid surveys-[blinded] Lumbar Spine Surgery Expectations Survey and [blinded] Cervical Spine Surgery Expectations Survey-Oswestry Disability Index (ODI), and Neck Disability Index (NDI).

Methods: Patients preoperatively completed a valid 20-item lumbar or cervical spine surgery Expectations Survey measuring the amount of improvement expected for symptoms, physical function, and mental well-being. Two years postoperatively, patients were asked about fulfillment of each expectation; a proportion was calculated as the amount of improvement received versus the amount of improvement expected. The proportion ranges from 0 (no expectations fulfilled) to 1 (all expectations fulfilled as expected), to >1 (expectations surpassed). Patients also completed the ODI or NDI, as well as questions about 2-year interval events, such as subsequent surgery.

Results: Among the 366 patients who had lumbar surgery, 90% had at least some of their expectations fulfilled (15% expectations surpassed, 9% expectations fulfilled as expected, and 66% expectations fulfilled somewhat) and 10% had none of their expectations fulfilled; the mean proportion of expectations fulfilled was .66. In multivariable analysis, variables that were associated with a lower proportion of expectations fulfilled were more preoperative expectations, not working full-time, previous spine surgery, surgery for more vertebral levels, subsequent spine surgery, and less improvement in pre- to postoperative ODI and pain scores (p≤.05 for all variables). Among the 133 patients who had cervical surgery, 91% had at least some of their expectations fulfilled (23% expectations surpassed, 8% expectations fulfilled as expected, and 60% expectations fulfilled somewhat) and 9% had none of their expectations fulfilled; the mean proportion of expectations fulfilled was .78. In multivariable analysis, variables that were associated with a lower proportion of expectations fulfilled were more preoperative expectations and less improvement in pre- to postoperative NDI and pain scores (p≤.05 for all variables).

Conclusions: Fulfillment of expectations after spine surgery is associated with multiple pre- and postoperative variables, including the amount of improvement expected preoperatively.